Monday, December 19, 2011

ΩAlthough the study was done in rats, scientists suggest the findings could help explain why many users of the therapy report health benefits

Acupuncture significantly reduces levels of a protein in rats linked to chronic stress, researchers at Georgetown University Medical Center (GUMC) have found. They say their animal study may help explain the sense of well-being that many people receive from this ancient Chinese therapy.

Published online in December in Experimental Biology and Medicine, the researchers say that if their findings are replicated in human studies, acupuncture would offer a proven therapy for stress, which is often difficult to treat.

"It has long been thought that acupuncture can reduce stress, but this is the first study to show molecular proof of this benefit," says the study's lead author, Ladan Eshevari, Ph.D., an assistant professor at Georgetown's School of Nursing & Health Studies, a part of GUMC.

Eshkevari, who is also a nurse anesthetist as well as a certified acupuncturist, says she conducted the study because many of the patients she treats with acupuncture in the pain clinic reported a "better overall sense of wellbeing — and they often remarked that they felt less stress."

While traditional Chinese acupuncture has been thought to relieve stress —in fact, the World Health Organization states that acupuncture is useful as adjunct therapy in more than 50 disorders, including chronic stress — Eshevari says that no one has biological proof that it does so.

So she designed a study to test the effect of acupuncture on blood levels of neuropeptide Y (NPY), a peptide that is secreted by the sympathetic nervous system in humans. This system is involved in the "flight or fight" response to acute stress, resulting in constriction of blood flow to all parts of the body except to the heart, lungs, and brain (the organs most needed to react to danger). Chronic stress, however, can cause elevated blood pressure and cardiac disease.

Eshevari used rats in this study because these animals are often used to research the biological determinants of stress. They mount a stress response when exposed to winter-like cold temperatures for an hour a day.

Eshevari allowed the rats to become familiar with her, and encouraged them to rest by crawling into a small sock that exposed their legs. She very gently conditioned them to become comfortable with the kind of stimulation used in electroacupuncture — an acupuncture needle that delivers a painless small electrical charge. This form of acupuncture is a little more intense than manual acupuncture and is often used for pain management, she says, adding "I used electroacupuncture because I could make sure that every rat was getting the same treatment dose."

She then selected a single acupuncture spot to test: Zuslanli (ST 35 on the stomach meridian), which is said to help relieve a variety of conditions including stress. As with the rats, that acupuncture point for humans is on the leg below the knee.

The study utilized four groups of rats for a 14-day experiment: a control group that was not stressed and received no acupuncture; a group that was stressed for an hour a day and did not receive acupuncture; a group that was stressed and received "sham" acupuncture near the tail; and the experimental group that were stressed and received acupuncture to the Zuslanli spot on the leg.

She found NPY levels in the experimental group came down almost to the level of the control group, while the rats that were stressed and not treated with Zuslanli acupuncture had high levels of the protein.

In a second experiment, Eshevari stopped acupuncture in the experimental group but continued to stress the rats for an additional four days, and found NPY levels remained low. "We were surprised to find what looks to be a protective effect against stress," she says.

Eshevari is continuing to study the effect of acupuncture with her rat models by testing another critical stress pathway. Preliminary results look promising, she says.

Wednesday, December 14, 2011

When you cut an apple and leave it out, it turns brown. Squeeze the apple with lemon juice, an antioxidant, and the process slows down.

Simply put, that same "browning" process-known as oxidative stress-happens in the brain as Alzheimer's disease sets in. The underlying cause is believed to be improper processing of a protein associated with the creation of free radicals that cause oxidative stress.

According to the Alzheimer's Society, more than 5 million Americans currently suffer from the neurodegenerative disease. Without successful prevention, almost 14 million Americans will have Alzheimer's by 2050, accounting for healthcare costs of more than $1 trillion a year.

Oxidative stress is believed to cause neurons in the brain to die, resulting in Alzheimer's. Study author James Franklin, an associate professor of pharmaceutical and biomedical sciences, has studied neuronal cell death and oxidative stress at UGA since 2004.

"The brain consumes 20 percent of the oxygen in the body even though it only makes up 5 percent of the volume, so it's particularly susceptible to oxidative stress," said Franklin, coauthor of the study along with Meagan McManus, who received her Ph.D. in neuroscience from UGA in 2010.

The UGA researchers hypothesized that antioxidants administered unsuccessfully by other researchers to treat Alzheimer's were not concentrated enough in the mitochondria of cells. Mitochondria are structures within cells that have many functions, including producing oxidative molecules that damage the brain and cause cell death.

"MitoQ selectively accumulates in the mitochondria," said McManus, who is now studying mitochondrial genetics and dysfunction as a postdoctoral researcher at Children's Hospital of Philadelphia.

"It is more effective for the treatment to go straight to the mitochondria, rather than being present in the cell in general," she said.

Although he had not previously conducted research on Alzheimer's disease, Franklin was moved to approve McManus' research proposal to take his laboratory research in a more clinical direction in part because of her family's history with the disease.

"Two of my grandparents had Alzheimer's disease, but they presented with it very differently. While my granddad often couldn't remember who we were, he was still the same soulful funnyman I'd always loved. But the disease changed my grandmother's mind in a different way, and turned her into someone we'd never known," said McManus.

"So the complexity of the disease was most intriguing to me. I wanted to know how and why it was happening, and more importantly, how to stop it from happening to other people," she said.

In their study, mice engineered to carry three genes associated with familial Alzheimer's were tested for cognitive impairment using the Morris Water Maze, a common test for memory retention. The mice that had received MitoQ in their drinking water performed significantly better than those that didn't. Additionally, the treated mice tested negative for the oxidative stress, amyloid burden, neural death and synaptic loss associated with Alzheimer's.

Guidelines for clinical management of patients with low back pain (LBP) encourage health care practitioners to advise staying active and returning to work. Despite this, most practitioners believe work factors can cause or exacerbate LBP, and a recommendation for a "short break from work" to allow healing is common. A new study in the December issue of Pain by researchers from the Department of Psychology, Royal Holloway, University of London finds that practitioners perceive their role in returning patients to work as limited, and believe that at least some aspects of work are detrimental to patients' recovery.

"Low back pain is consistently among the top most costly health problems. Back pain has been identified as the second main cause of absenteeism in the UK. Our findings suggest that, despite guidelines that encourage maintaining people at work during episodes of back pain, many clinicians hold a range of beliefs that contradict this advice, and these beliefs can influence their clinical decisions and behaviors," explains lead author Professor Tamar Pincus, PhD.

Researchers measured work-related behaviors and beliefs related to low back pain among osteopaths, physiotherapists, and chiropractors across the UK. After general practitioners, these three groups most commonly treat LBP in the UK. The authors measured how frequently these practitioners visited a patient's workplace, provided sick leave certificates, recommended a break from work for recovery, and prescribed exercises that could be incorporated into the patient's work routine. The Attitudes to Back Pain Scale for musculoskeletal practitioners was included to explore the relationship between general beliefs about back pain and work-related behaviors, such as whether the practitioner limits the number of sessions for the treatment of low back pain, and believes that increasing mobility should be a goal of treatment. Finally, the authors examined practitioners' beliefs about: the benefit vs. threat of work to health in general and back pain in particular; the work-related roles of musculoskeletal practitioners; the need for patients to take a short break to recover from LBP; and practitioners' perception of employers' willingness to help patients with LBP.

Advising patients to take work absence was extremely common. Eighty percent of respondents reported recommending work absence to patients with LBP sometimes, and an additional 13% reported that they do so often or always. While 70% of practitioners never visited the workplace to advise and prescribe ergonomic changes, investigators found that a common practice was the prescription of exercises that could be incorporated into the work routine, with 83% reporting that they do so always or often. Although it was common to recommend a short break from work, less than 2% of respondents prescribed sick leave certification for LBP often or always.

Physiotherapists, who in the UK are employed by the National Health Service, more strongly endorsed the benefits of work to aid in recovery from LBP than either osteopaths or chiropractors, who typically work in the private sector. Physiotherapists also agreed significantly less with the notion that work can either cause or exacerbate pain, and they tended to endorse limiting the number of treatment sessions for LBP.

Reports of visiting the workplace directly and contacting employers to allow for coordinated action to support people staying at work during LBP were extremely low in this study. "Integrated care at work has shown promising results in earlier clinical trials. If return to work is beneficial to patients and is a primary goal for cost savings, bringing these practitioners on board and altering their perceptions of the individual-employer-clinician triad is important," says Dr. Pincus.

###The article is "Advising people with back pain to take time off from work: A survey examining the role of private musculoskeletal practitioners in the UK," by T. Pincus, L. Greenwood, and E. McHarg (DOI: 10.1016/j.pain.2011.09.010). It appears in Pain, Volume 152, Issue 12 (December 2011) published by Elsevier.

Tuesday, December 6, 2011

Acupuncture for chemotherapy-induced peripheral neuropathy: A pilot study using neurography

Acupuncture may help ease the severe nerve pain associated with certain cancer drugs, suggests a small preliminary study published in Acupuncture in Medicine.

Cancer patients treated with taxanes, vinca alkaloids, or platinum compounds can develop a condition known as chemotherapy induced peripheral neuropathy, or CIPN for short, as a by-product of their treatment. These powerful drugs can damage peripheral nerves, particularly in the calves and feet, which can result in severe nerve pain and/or difficulty walking. As yet, there is no effective antidote.

Out of a total of 192 patients with peripheral neuropathy eligible for inclusion in the study, 11 had developed their symptoms during a course of chemotherapy for various types of cancer. Six of these patients agreed to undergo acupuncture; the other five served as a comparison group.

Twenty needles were inserted at prescribed points and depths and left in place for 20 minutes during each of the 10 sessions. These were delivered over a period of three months by a senior doctor, who had been fully trained in acupuncture and had used the technique for 20 years.

Nerve conduction studies, to assess the signalling speed and intensity of two nerves in the same calf were carried out before acupuncture and again six months after chemotherapy in the six volunteers. The same studies on patients in the comparison group were carried out after they had completed their chemotherapy and then again six months later.

At the second neurological assessment, patients in both groups were asked to state whether they thought their condition had changed or stayed the same.

Clinical examination showed that all the patients had a mixture of numbness on touch and nerve pain, while nerve conduction studies showed evidence of damage to the sural nerve.

In those given acupuncture, both the speed and the intensity of the nerve signalling improved in five out of the six patients. And these same patients said their condition had improved. Among those in the comparison group, speed remained the same in three, fell in one, and improved in one. Intensity remained the same in one, improved in two, and decreased in two.

The authors point to previous research, which suggests that acupuncture may boost blood flow in the legs, which may in turn aid the repair of nerve damage.

"The data suggest that acupuncture has a positive effect on CIPN, as measured by objective parameters [nerve conduction studies]," write the authors, adding that their results are similar to those found in patients with nerve damage caused by diabetes and those with peripheral neuropathy of unknown cause.

They conclude that the results of this pilot study are "encouraging," and merit further investigation in a larger trial.